University of Wisconsin-River Falls

INTERNATIONAL TRAVELING CLASSROOM (ITC)
APPLICATION

This form may be filled out online, printed, and then signed OR printed and then filled out by hand (print clearly) and delivered to the group leader. Complete all information.

Name  

Current Year in School (completed credits)
Local Address    Senior (90+ credits)
   Junior (60-89 credits)
   Sophomore (30-59 credits)
   Freshman (0-29 credits)
E-mail Address
Falcon ID: W Current grade point average
Local Phone # Major/Minors(s)
Permanent Address Permanent Phone #
   
How likely are you to participate in the ITC?
Place me on the "definite" list Place me on the "possibly" list
Identify the spring semester(s) that you are interested in participating:

 

Submission of a deposit in the amount of $150.00 is necessary to reserve a slot in the Program. Be sure to include your student ID number on the check, and identify your year (e.g. write the check out to "2009 ITC," if you are applying for spring 2009). Deliver the check to the Cashier's Office (217 North Hall, 425-3805)

I understand that my slot remains reserved only as long as I meet the expectations identified below, and I grant permission to the ITC staff to access my records for screening purposes.

By choosing to participate in the ITC I agree to abide by University and Program guidelines, fulfill the requirements established in the ITC Handbook, and complete all tasks related to the Program. I understand that I must attend all orientation seminars, provide all requested documentation, maintain good academic standing (e.g., not be on academic probation), have a minimum cumulative grade point average of 2.25 at the end of the fall term preceding departure, and obtain a letter of recommendation from a University faculty or staff member who can address my ability to participate successfully in the ITC.

I understand that I am under absolutely no obligation unless I provide a deposit, but if I do provide a deposit it becomes non-refundable (unless the program is cancelled). I also agree that if I have not withdrawn in writing and have not received a written confirmation of my withdrawal by September preceding departure that I will be obligated to pay a second, non-refundable deposit of $350 and the Program Fee as part of my spring tuition and fees (the Program fee covers the expenses of the program including, but not limited to, the following: airline tickets, some local transportation, costs of group-arranged accommodations, and so on).

I also understand that this is a reasonably demanding physical endeavor and that disability services are significantly more limited in Europe than in the United States .

Signature & date: _______________________________________________

Deliver to: Dr. Rik Seefeldt, CSH 169, 425-4689, richard.seefeldt@uwrf.edu



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